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Thoraco-Lumbar > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

Clinical reasoning can be impaired by:

A

Fragmentation of interpretation, Overreliance on classical interpretations, Less adequate knowledge

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2
Q

T/F experience is a safeguard against judgement errors

A

F

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3
Q

Voytovich and Rippey studied errors in what four categories?

A

Wrong synthesis (data contradiction), Omission (ignoring a clue), Inadequate synthesis (conclusion not completely supported by data), and premature closure

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4
Q

What is anchoring?

A

Tendency to retain hypothesis in spite of subsequent information

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5
Q

What is countertransference?

A

Fears of harming the patient, loss of control, and performance anxiety

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6
Q

Engler suggests that data-gathering requires what?

A

Communication and rapport with the client

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7
Q

What are some common problems of history-taking?

A

Omission of probing questions, Leading questions, Complex vocabulary, Not allowing enough time for the patient to speak, ignoring silence, and missing non-verbal signs

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8
Q

T/F Leavitt et al. shows back pain malingering is not strongly tied to workers’ compensation

A

T

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9
Q

Pain is a _____ not a diagnosis

A

Symptom

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10
Q

What % of back pain originates from musculoskeletal problems?

A

75-85%

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11
Q

10% of back pain orignate form ______ _______.

A

Unknown etiology

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12
Q

What % of the population suffers from LBP at some point?

A

50-80%

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13
Q

What % of back pain reoccurs?

A

30-70%

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14
Q

What portion of the vertebra bears most compressive loads?

A

Anterior

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15
Q

What portion of the annulus is innervated?

A

The outer half

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16
Q

What are the soft tissue components of the motion unit supplied by?

A

The sinu-vertebral nerve

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17
Q

Large afferent fibers transmit what?

A

Mechanoreception

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18
Q

Where do the large afferent fibers travel?

A

The dorsal horn -> substantia gelatinosa -> dorsal columns -> medial lemnisucs -> VPL thalamus -> post-central gyrus

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19
Q

What do small afferent fibers carry?

A

Nociception

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20
Q

Where do the small afferent fibers travel?

A

The tract of Lissauer -> dorsal horn -> anterior white commisure -> anterolateral tract -> VPL and VPM thalamus -> limbics, hypothalamus, medullary RF

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21
Q

C fiber stimulation causes?

A

Hyperpolarization of the substantia gelatinosa inhibitory interneurons

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22
Q

What does A-beta fiber stimulation cause?

A

Depolarization of the inhibitory interneurons

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23
Q

What cell type is an inhibitory interneuron?

A

T-cells

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24
Q

What substances produce an endogenous analgesic effect?

A

Endogenous opiates and enkephalins

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25
Q

Soft tissue irritation causes cell membrane breakdown and the formation of what substances?

A

prostaglandins, thromboxane, monohydroxy fatty acids, and leukotrienes

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26
Q

What 3 reactions determine whether a person finds a stimulus painful?

A

Neurologic, Biomechanic, and Emotional reaction

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27
Q

How many persons with low back pain are functioning again within a week?

A

75%

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28
Q

What is the timeline for acute and chronic pain formation?

A

Acute 0-1 week
Subacute 0-7 weeks
Chronic 7+ weeks

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29
Q

Fatigue, anxiety, and lack of activity increase with what?

A

Chronic pain

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30
Q

What factors correlate with the ability to return to work?

A

Length of sickness, absence period, need for analgesics, attitude to the problem, cervical and lumbar pain

31
Q

What type of strength reduces pain?

A

isokinetic extensor strength

32
Q

What is the most common psychological condition seen in chronic pain?

A

Depression/Intermittent depressive disorders

33
Q

What pain is associated with worse coping mechanisms, myofascial or low back pain?

A

LBP

34
Q

What types of dermotogenous pains are there?

A

Fast and Slow

35
Q

Describe dermatogenous pain.

A

Sharp, lancinating, and clearly localized

36
Q

What part of the motion unit is the source of most pain?

A

DRG or dorsal root

37
Q

Where do most disk herniation occur?

A

L4-5 or L5-S1

38
Q

Which side and disk has a greater propensity for injury?

A

L4-5 on the right side

39
Q

What structure makes posterolateral disc (lumbar) protrusions more likely?

A

PLL (Tapers at the bottom)

40
Q

Rank positions of disk pressure from least to greatest.

A

Supine -> standing -> sitting -> forward flexion + standing or sitting

41
Q

What is another name for a medial disc protrusion?

A

Axillary

42
Q

If a disk bulge irritates the apophysis, what type of motion produces pain?

A

Any motion

43
Q

What structure are involved in scleratogenous pain?

A

Periosteum, joint capsule, subchondral bone, tendon, ligaments, articular cartilage, and synovium

44
Q

What scleratogenous structures are most sensitive to pain?

A

Joint capsules and periosteum

45
Q

Describe scleratogenous pain

A

Dull and vague at rest and more intense with activity

46
Q

What types of symptoms often accompany scleratogenous pain?

A

Autonomic; pallor, sweating, nausea, low blood pressure

47
Q

What is myotogenous pain?

A

Deep muscle pain

48
Q

Describe muscle pain

A

Subtle at rest and aggravated by movement of said muscle group

49
Q

What might muscle spasm become?

A

Trigger points

50
Q

Where can trigger points occur?

A

Muscle, fascia, ligaments, pericapsular tissue and tendons

51
Q

What types of trigger points are there?

A

Acute and latent

52
Q

What are potential treatments for trigger points?

A

Local injection, massage, exercise, stretching, vapo-coolants, ischemic compression, ice massage, TENS, periosteal therapy, heat, and ultrasound

53
Q

What are primary sensory modalities?

A

Pain, Temperature, Light touch, Position, and Vibration

54
Q

What are secondary sensory modalities?

A

Higher cortical integration (parietal lobe), i.e. two point discrimination, awareness, graphesthesia, stereognosis

55
Q

What do thoracic dermatomes tend to follow?

A

Intercostal nerves

56
Q

T/F Thoracic dermatomes are easily distinguishable

A

False, they are difficult to separate

57
Q

What lumbar discs are unusual to have lesions in?

A

L1-L2; L2-L3

58
Q

Does proprioception ascend the contralateral or ipsilateral side of origin?

A

Ipsilateral

59
Q

What is lost early in peripheral neuropathy?

A

Vibratory sensation

60
Q

What levels may be involved in a large protrusion?

A

Anything below the level of disc protrusion

61
Q

What is integrated to control posture?

A

Vestibular, Visual, and Proprioception

62
Q

Most muscles are in what state?

A

Semi-contracted

63
Q

L3-L4 motion unit pathology may lead to atrophy of what?

A

Quadriceps

64
Q

L4-L5 motion unit pathology may lead to atrophy of

A

Anterior Tibial muscles

65
Q

L5-S1 motion unit pathology may lead to atrophy of

A

Gastrocnemius and Soleus muscles

66
Q

Deep tendon reflex is contingent on the function of what structures?

A

Muscle spindle, afferent nerves, DRG, efferent pathway, peripheral nerves

67
Q

Does a DTR perform better or worse in the cold?

A

Worse

68
Q

Protective reflex of paravertebral muscles reduces what motion?

A

Flexion

69
Q

Organic pain is likely to be associated with what?

A

Lumbar kyphosis

70
Q

What is often the result of osteoporotic vertebral compression?

A

Thoracic kyphosis

71
Q

Asymmetric paravertebral muscle spasm may lead to what in a patient with disk herniation?

A

Scoliotic postures

72
Q

What does the osteopathic evaluation of manipulative lesions mnemonic A.R.T stand for?

A

A - Asymmetry
R - RoM
T - Tissue/texture abnormalities

73
Q

T or F: If one sagittal curve of the spine is increased, the other curves will increase

A

T

Thoraco-Lumbar (1 decks)

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